Name
____________________ Date __________ Period ___
Health
Through Film & Fiction – Contagion
***Adapted and credit given to Morgan Park High School for the use of this lesson!
Overview: In this lesson, students
consider the movie Contagion in the
context of public health, epidemics, and the nature of disease outbreaks.
Movie Questions:
- What is the movie
about?
- What emotions did you
feel as you watched? How did the characters, images, dialogue and
background music contribute to your perceptions and feelings?
- Which elements seemed
realistic? Did anything strike you as having been dramatized for the sake
of the story?
- Explain how this outbreak is a “pandemic” and
not an “epidemic”. What is the
difference?
- Describe some of the ways in which the movie Contagion incorporates actual
events or facts about contagious diseases into its storyline.
- What do you remember about recent global
pandemics, like the H1N1 flu, or more localized outbreaks, like measles?
Does the statement that “pandemics
are never everywhere” ring true in your knowledge of these or other
contagious diseases? Explain.
- What were the strains of the virus? MEV-1 and what else? What were they?
- Take a
moment to research “SARS”. What is
that? Tell me a bit about it.
September 12, 2011
The Cough That Launched a Hit Movie
By ABIGAIL ZUGER, M.D.
When Hollywood turns to medicine, accuracy
generally heads for the hills. But the creators of the new action thriller
“Contagion” went to unprecedented lengths to fact-check their story of a
destructive viral pandemic, retaining a panel of nationally renowned
virologists and epidemiologists as consultants. The intent was to infuse the
usual hyperbole with an extra frisson: This is the way it could really happen.
Be very afraid. You have to applaud the effort, for the movie does indeed offer a procession of dead-on accurate scenes that not only could happen but, in many cases, have already happened. Still, the whole thing is an improbable caricature, with 100 action-packed Hollywood minutes veering far from reality. You can still be very afraid if you want, if a contagious apocalypse happens to be your thing. But it’s not going to happen this way.
“Contagion” begins modestly and realistically enough, with a cough. Gwyneth Paltrow, a midlevel executive for an international corporation, gets sick on her way home from a business trip. She coughs from Hong Kong through a layover in Chicago and on to Minneapolis, producing clouds of a deadly Asian virus and leaving infectious droplets on everything she touches. She is the pandemic’s index case, and her napkins, used tissues, drinking glasses and three-ring binder are all vectors of disease.
Her infection is a fictional combination of influenza and brain infection caused by the exotic Nipah virus. Nipah (NEE-pa) is carried by fruit bats in South Asia: bats don’t get sick from it, but their saliva and urine may infect pigs, which do. Sick pigs have transmitted Nipah to their human caretakers, and in the dozen small outbreaks described since 1999, sick humans sometimes passed it on to their own caretakers. The disease has never been seen outside a rural setting and has certainly never traveled on a plane. Still, Nipah, with its 50 to 75 percent mortality rate in humans, tops most lists of scary new animal-derived viruses.
The creators of “Contagion” scaled down the mortality rate of their “MEV-1” virus infection to 25 percent (for comparison, the mortality rate of SARS in 2003 was about 15 percent, and that of even the worst influenza substantially less). Then they jacked up the viral infectivity so that a few days into the fictional epidemic dozens of unrecognized cases already dot the globe. By the time Kate Winslet, who plays an epidemiologist at the Centers for Disease Control and Prevention, gets off her plane in Minneapolis, that city has enough brewing cases to fill a couple of football fields with hospital beds. A few weeks later, with disease exploding everywhere, the world’s social fabric begins to dissolve.
What follows is a series of gruesome worst-case scenarios, crumpling together every conceivable social and ethical complication of epidemic disease, for what boils down to a giant in-your-face public-service advertisement for the world’s beleaguered health agencies.
The medical details, including the rapid demise of several excellent actors (after some highly unrealistic foaming at the mouth) are the least of it.
We also experience, in short order, the downside of contact tracing, a time-honored epidemiologic term for figuring out who has touched whom — all privacy immediately disappears. Likewise, a forced quarantine, the major tool for fighting contagious disease, sacrifices individual rights for the public good. Competing governmental agencies square off on turf and budget issues, while entire countries adopt aggressively misguided routines.
We see gigantic public mood swings, amplified by Internet scares. Some people become irrationally terrified, others irrationally fearless. Many succumb to the lure of unlikely patent medicines. Unscrupulous entrepreneurs quickly appear, like maggots, to feed these instincts and to feed off them.
We see selfish and selfless behavior, often in the same person. We see unexpected scientific setbacks (“It’s mutated!”) and slow steps to ultimate control. All unfold against the eerie visuals of quarantine, with uncollected garbage lining deserted streets, empty public spaces, masked faces, isolated clusters of families reduced to a primitive, almost tribal existence.
And indeed, from AIDS to SARS to the swine flu, pretty much all of this has actually happened somewhere in the world, if on a much smaller scale.
But for all the relentless realism, much of the real drama of epidemic disease never quite makes it to the screen.
First, nowhere but in Hollywood does medicine, even in its most catastrophic form, unfold with the sustained hysteria that requires the beat of this unnerving, tympanitic score.
The real horror of most disease is that it all moves so slowly, leaving everyone involved all too much time to think. The worse the illness, the more time seems to drag.
And that is not only for relatives sitting in waiting rooms. At every medical ground zero, doctors and nurses pace and dither and second-guess themselves, waiting for tests to be done and results to dribble back, cursing when the IV falls out and struggling forever to put it back in, counting days and doses, watching trends. Patients do nothing but wait for the next footfall outside their door. Waiting is where much of the real drama of contagion lies. But you cannot make a movie out of that.
Further, while medical heroics may abound these days, characters like Ms. Winslet’s are vanishingly rare. Medicine has become a team sport, and public health even more so. It rumbles forward like any bureaucracy, creating policy in a series of endless meetings — deadly for narrative purposes. So character-driven screenplays like this one become parables, with cardboard characters standing in for what is really a nuanced cast of thousands.
Finally, pandemics are never everywhere. Even in the midst of history’s worst, ordinary life has always lurched on. Millions died from the flu in 1918, but many more millions were untouched. The early years of AIDS unfolded against a breathtakingly bland backdrop — the social equivalent of the crystalline blue sky on 9/11. Walk one block from hospitals on whose wards all hell is breaking loose and you would never know there is a problem.
The bizarre disconnect cocooning AIDS fueled an anger in affected communities that persists to this day. You cannot tell the story of AIDS without exploring the surrounding silence.
So artists seeking to represent the realities of epidemic disease have a difficult mission. The noise and action are only half the story. The rest is all very pedestrian and quiet.
The C.D.C.’s main spokeswoman during the 2009 H1N1 flu pandemic was Dr. Anne Schuchat, director of immunization and respiratory diseases. Dr. Schuchat, who has been with the agency for almost 25 years, has been involved with dozens of epidemics. She has the standard drills down cold — in fact, the creators of “Contagion” enlisted her to coach Ms. Winslet before filming began.
But in an essay published a few months ago in The American Journal of Obstetrics and Gynecology that reflected on the toll H1N1 took among pregnant women, Dr. Schuchat veered away from the usual story line.
“Pandemics are personal,” Dr. Schuchat began, going on to tell the story of her great-aunt Bessie, who was killed during childbirth by the 1918 flu. Bessie’s death resounded through generations of the Schuchat family, just one of the millions of quiet, necessary footnotes without which the big glitzy narratives are neither accurate nor complete.
